Left Atrial Appendage Ligation (LAL)

Left Atrial Appendage Ligation (LAL), also known as left atrial appendage closure, is a procedure that uses the AtriClip® System to permanently close off your left atrial appendage (LAA) — a pouch-like extension of your heart where blood clots commonly form in people who have atrial fibrillation (AFib).

By closing off the LAA and preventing blood clots from forming, LAL may reduce stroke risk and eliminate the need for you to take blood-thinning medications.

What Is LAL?

LAL is a procedure used to reduce the risk of stroke in patients with AFib. During LAL, your provider will permanently seal off your LAA from the rest of your heart. This prevents blood from circulating through and pooling in your LAA and causing clots, potentially decreasing your risk of stroke and eliminating the need to take blood-thinning medications.

Types of left atrial appendage closures

There are two types of procedures, including:

• Catheter-based LAA closure — Performed by an interventional cardiologist through a small incision using devices such as the Watchman.
• Surgical LAA closure —Performed by a cardiac surgeon and uses the AtriClip device to permanently close off the LAA at its base. Some people have surgical LAA closure during cardiac surgery for another condition.

Conditions we treat with LAL

• Stroke risk related to AFib

Why Would I Need LAL?

Your doctor may recommend LAL if you have been diagnosed with AFib and are unable to take blood-thinning medications due to a risk of bleeding or falls.        

Who’s a candidate for LAL?

You may be a candidate for LAL if:

• You have been diagnosed with AFib.
• You are unable to take blood thinners.
• You are at high risk of having a stroke.

Alternatives to LAL

• Blood-thinning medications.
• Catheter-based LAA closure (Watchman).

What Are the Risks and Complications of LAL

LAL is a safe and effective procedure when it is performed by an experienced cardiac surgeon. However, there are risks associated with any medical procedure. Risks of LAL include:

• Bleeding.
• Cardiac arrest.
• Chest pain.
• Excess fluid around the heart.
• Infection.
• New or worsening abnormal heart rhythm.
• Problems with the LAA closure device.

What Should I Expect From LAL?

Before: How to prepare for LAL

Your doctor will explain the LAL procedure to you and give you a chance to ask questions. To prepare for a LAL procedure, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure. 
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your LAL procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will stay in the hospital for at least one night, so you should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should arrange for someone to drive you home after you are discharged.

How long does LAL take?

LAL procedures typically take 2-4 hours. The time of your LAL procedure will depend on whether you are having other procedures, such as coronary artery bypass graft (CABG) surgery or heart valve surgery, at the same time. You will spend one or more nights in the hospital after your LAL procedure.

During your LAL

During your LAL, you will be under general anesthesia. If you are having cardiac surgery to treat another condition, your doctor may perform LAL at the same time.

What is the procedure to close the left atrial appendage?

During the procedure, your doctor will:

• Make a small incision in your chest.
• Insert a catheter into your left atrium. The catheter carries the AtriClip to the outside surface of your LAA.
• Open up the AtriClip like an umbrella to permanently close off your LAA at its base. This prevents blood from circulating through and pooling in the appendage.
• Remove the catheter and close your incision.

Recovery after LAL

After your LAL, you will be taken to the recovery room for observation. Then you will be returned to your hospital room where a nurse will monitor your vital signs. You will need to spend at least one night (possibly more) in the hospital so your health care team can monitor your condition.

Your doctor will let you know when you can return to your normal activities and will schedule you for a follow-up appointment after your procedure.

When to call your doctor about complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• Pain, redness, bleeding, drainage, or increased swelling at your incision site.
• Burning or pain in your chest.
• A fever of more than 100.0°F.
• New or increasing shortness of breath.
• Difficulty breathing.
• Difficulty swallowing, throat pain, or bloody cough.
• Redness or rash on your chest or back.

What’s the prognosis of LAL?

Because LAL permanently closes off your LAA, it significantly reduces long-term stroke risk.

Will I need blood thinners after left atrial appendage ligation?

You may need to continue taking blood thinners for several weeks or months after your LAL procedure. After a few months, most patients are able to stop taking blood-thinning medications.

What’s the success rate of LAL?

Research shows that LAL with an AtriClip device has a success rate of more than 90 percent. Your doctor will discuss the expected success rate for your procedure with you.

Why Choose UPMC for LAL?

When you choose UPMC for your LAL procedure, you will receive expert care from some of the region's most experienced cardiovascular surgeons and interventional cardiologists. Our doctors use the latest, most effective methods to perform LAL procedures and are pioneers in the use of the AtriClip System in clinical trials.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.